{"id":1582,"date":"2022-10-14T13:04:42","date_gmt":"2022-10-14T20:04:42","guid":{"rendered":"http:\/\/thunderbirdlaw-dev.flywheelsites.com\/?page_id=1582"},"modified":"2022-10-14T13:23:43","modified_gmt":"2022-10-14T20:23:43","slug":"confidential-intake-form","status":"publish","type":"page","link":"https:\/\/thunderbirdlawgroup.com\/es\/confidential-intake-form\/","title":{"rendered":"Confidential Intake Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1582\" class=\"elementor elementor-1582\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5ac6e01 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"5ac6e01\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6650343\" data-id=\"6650343\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-380dfda elementor-widget elementor-widget-heading\" data-id=\"380dfda\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.19.0 - 28-02-2024 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h2 class=\"elementor-heading-title elementor-size-default\">confidential intake form<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-67233a9 elementor-widget elementor-widget-text-editor\" data-id=\"67233a9\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.19.0 - 28-02-2024 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_1' ><div id='gf_1' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_1' id='gform_1'  action='\/es\/wp-json\/wp\/v2\/pages\/1582#gf_1' data-formid='1' novalidate>\n        <div id='gf_progressbar_wrapper_1' class='gf_progressbar_wrapper'>\n        \t<h3 class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>9<\/span> &#8211; General Information\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_0' style='width:0%;'><span>0%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_1_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_above'><li id=\"field_1_99\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_99\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Disclaimer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_99'>Please check the Box to Continue to the next page.   By checking the Box and completing the completing the Intake Form you understand and acknowledge that: (1) you are submitting information through the Intake Form solely for the purpose of allowing Thunderbird Law Group PLLC (\u201cFirm\u201d) to review information regarding possible legal representation; (2) completing the Intake Form does not create an attorney-client relationship and the Firm has not accepted any duty to file a lawsuit or take any action on your behalf; (3) the Firm may need further information to make a decision regarding representation; (4) the Firm will contact you if we need additional information or to schedule a meeting to discuss possible representation; (5) the Firm charges a Consultation Fee of $400.00 for an In-Person Consultation, unless you are specifically offered a waiver; and (6) all the information you provide during the evaluation process is privileged and confidential. <\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_99'><li class='gchoice gchoice_1_99_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_99.1' type='checkbox'  value='I understand and agree.'  id='choice_1_99_1'   aria-describedby=\"gfield_description_1_99\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_99_1' id='label_1_99_1' class='gform-field-label gform-field-label--type-inline'>I understand and agree.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_1_90' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_2' class='gform_page' data-js='page-field-id-90' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_2' class='gform_fields top_label form_sublabel_below description_above'><li id=\"field_1_15\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gf_left_third field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_15\" ><label class='gfield_label gform-field-label' for='input_1_15'>When were you hired?<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_15' id='input_1_15' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_1_15_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_1_15_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_1_15' class='gform_hidden' value='https:\/\/thunderbirdlawgroup.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_1_16\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gf_middle_third field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_16\" ><label class='gfield_label gform-field-label' for='input_1_16'>When were you fired?<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_16' id='input_1_16' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_1_16_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_1_16_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_1_16' class='gform_hidden' value='https:\/\/thunderbirdlawgroup.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_1_3\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_third field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_3\" ><label class='gfield_label gform-field-label' for='input_1_3'>Job Title \/ Position Held<\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_1_3' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_4\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_third field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_4\" ><label class='gfield_label gform-field-label' for='input_1_4'>Your most recent salary or hourly rate with the employer<\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_1_4' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_5\" class=\"gfield gfield--type-text gfield--input-type-text gf_middle_third gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_5\" ><label class='gfield_label gform-field-label' for='input_1_5'>Name of Employer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_1_5' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_6\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_third field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_6\" ><label class='gfield_label gform-field-label' for='input_1_6'>City you worked in<\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_1_6' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_7\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_7\" ><label class='gfield_label gform-field-label' for='input_1_7'>Number of employees at company:<\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_1_7' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_11\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_11\" ><label class='gfield_label gform-field-label' >Do you have a written employment contract?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_11'>\n\t\t\t<li class='gchoice gchoice_1_11_0'>\n\t\t\t\t<input name='input_11' type='radio' value='Yes'  id='choice_1_11_0'    \/>\n\t\t\t\t<label for='choice_1_11_0' id='label_1_11_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_11_1'>\n\t\t\t\t<input name='input_11' type='radio' value='No'  id='choice_1_11_1'    \/>\n\t\t\t\t<label for='choice_1_11_1' id='label_1_11_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_12\" ><label class='gfield_label gform-field-label' >Have you signed a form stating that you agree to submit all disputes related to your employment to arbitration?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_12'>\n\t\t\t<li class='gchoice gchoice_1_12_0'>\n\t\t\t\t<input name='input_12' type='radio' value='Yes'  id='choice_1_12_0'    \/>\n\t\t\t\t<label for='choice_1_12_0' id='label_1_12_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_12_1'>\n\t\t\t\t<input name='input_12' type='radio' value='No'  id='choice_1_12_1'    \/>\n\t\t\t\t<label for='choice_1_12_1' id='label_1_12_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_12_2'>\n\t\t\t\t<input name='input_12' type='radio' value='I don&#039;t know'  id='choice_1_12_2'    \/>\n\t\t\t\t<label for='choice_1_12_2' id='label_1_12_2' class='gform-field-label gform-field-label--type-inline'>I don&#8217;t know<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_13\" ><label class='gfield_label gform-field-label' >Are you a member of a Union<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_13'>\n\t\t\t<li class='gchoice gchoice_1_13_0'>\n\t\t\t\t<input name='input_13' type='radio' value='Yes'  id='choice_1_13_0'    \/>\n\t\t\t\t<label for='choice_1_13_0' id='label_1_13_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_13_1'>\n\t\t\t\t<input name='input_13' type='radio' value='No'  id='choice_1_13_1'    \/>\n\t\t\t\t<label for='choice_1_13_1' id='label_1_13_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_14\" ><label class='gfield_label gform-field-label' >Have you filed a grievance with your union regarding this problem?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_14'>\n\t\t\t<li class='gchoice gchoice_1_14_0'>\n\t\t\t\t<input name='input_14' type='radio' value='Yes'  id='choice_1_14_0'    \/>\n\t\t\t\t<label for='choice_1_14_0' id='label_1_14_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_14_1'>\n\t\t\t\t<input name='input_14' type='radio' value='No'  id='choice_1_14_1'    \/>\n\t\t\t\t<label for='choice_1_14_1' id='label_1_14_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_98' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_98' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_3' class='gform_page' data-js='page-field-id-98' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_3' class='gform_fields top_label form_sublabel_below description_above'><li id=\"field_1_17\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_17\" ><h2 class=\"gsection_title\">Confidential Questionnaire<\/h2><div class='gsection_description' id='gfield_description_1_17'>This questionnaire is meant solely for the use of the consulting attorney for purposes of analyzing and evaluating the prospective client&#8217;s case. The contents of this document are therefore protected by the attorney-client privilege and the attorney work product doctrine. It is very important that you be completely truthful, accurate, and complete in answering the following questions.<\/div><\/li><li id=\"field_1_18\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_18\" ><label class='gfield_label gform-field-label' for='input_1_18'>How did you find us?<\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_1_18' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_35\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_35\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Your Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_35'>\n                            \n                            <span id='input_1_35_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_35.3' id='input_1_35_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_35_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_35_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_35.6' id='input_1_35_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_35_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_1_20\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_third field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_20\" ><label class='gfield_label gform-field-label' for='input_1_20'>Home Number<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_1_20' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_21\" class=\"gfield gfield--type-text gfield--input-type-text gf_middle_third gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_21\" ><label class='gfield_label gform-field-label' for='input_1_21'>Mobile Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_1_21' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_22\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_third field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_22\" ><label class='gfield_label gform-field-label' for='input_1_22'>Work Phone<\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_1_22' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_34\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_34\" ><label class='gfield_label gform-field-label' for='input_1_34'>Your Email:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_34' id='input_1_34' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_1_33\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_33\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Home Address:<\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_1_33' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_33_1_container' >\n                                        <input type='text' name='input_33.1' id='input_1_33_1' value=''    aria-required='false'    \/>\n                                        <label for='input_1_33_1' id='input_1_33_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_1_33_2_container' >\n                                        <input type='text' name='input_33.2' id='input_1_33_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_33_2' id='input_1_33_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_33_3_container' >\n                                    <input type='text' name='input_33.3' id='input_1_33_3' value=''    aria-required='false'    \/>\n                                    <label for='input_1_33_3' id='input_1_33_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_1_33_4_container' >\n                                        <input type='text' name='input_33.4' id='input_1_33_4' value=''      aria-required='false'    \/>\n                                        <label for='input_1_33_4' id='input_1_33_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_1_33_5_container' >\n                                    <input type='text' name='input_33.5' id='input_1_33_5' value=''    aria-required='false'    \/>\n                                    <label for='input_1_33_5' id='input_1_33_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_33.6' id='input_1_33_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_1_31\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_31\" ><label class='gfield_label gform-field-label' for='input_1_31'>Current Employer<\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_1_31' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_32\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gf_right_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_32\" ><label class='gfield_label gform-field-label' for='input_1_32'>Date current employment obtained:<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_32' id='input_1_32' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_1_32_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_1_32_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_1_32' class='gform_hidden' value='https:\/\/thunderbirdlawgroup.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_1_36\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_36\" ><label class='gfield_label gform-field-label' for='input_1_36'>You are seeking advice regarding your employment at:<\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_1_36' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_37\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_37\" ><label class='gfield_label gform-field-label' for='input_1_37'>If terminated, list former employer here:<\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_1_37' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_38\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_38\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Address of former employer:<\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_1_38' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_38_1_container' >\n                                        <input type='text' name='input_38.1' id='input_1_38_1' value=''    aria-required='false'    \/>\n                                        <label for='input_1_38_1' id='input_1_38_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_1_38_2_container' >\n                                        <input type='text' name='input_38.2' id='input_1_38_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_38_2' id='input_1_38_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_38_3_container' >\n                                    <input type='text' name='input_38.3' id='input_1_38_3' value=''    aria-required='false'    \/>\n                                    <label for='input_1_38_3' id='input_1_38_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_1_38_4_container' >\n                                        <input type='text' name='input_38.4' id='input_1_38_4' value=''      aria-required='false'    \/>\n                                        <label for='input_1_38_4' id='input_1_38_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_1_38_5_container' >\n                                    <input type='text' name='input_38.5' id='input_1_38_5' value=''    aria-required='false'    \/>\n                                    <label for='input_1_38_5' id='input_1_38_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_1_38_6_container' >\n                                        <select name='input_38.6' id='input_1_38_6'   aria-required='false'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_1_38_6' id='input_1_38_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_1_39\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_39\" ><label class='gfield_label gform-field-label' for='input_1_39'>How many employees work in the company?<\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_1_39' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_91' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_91' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_4' class='gform_page' data-js='page-field-id-91' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_4' class='gform_fields top_label form_sublabel_below description_above'><li id=\"field_1_41\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_41\" ><label class='gfield_label gform-field-label' for='input_1_41'>What is your complaint?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_1_41' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_42\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_42\" ><label class='gfield_label gform-field-label' for='input_1_42'>If terminated, state what your employer said its reasons were for terminating you. (If you were told it was a layoff, state the reason your employer gave for selecting you for layoff instead of other employees that hold the same or similar positions):<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_42' id='input_1_42' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_43\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_43\" ><label class='gfield_label gform-field-label' for='input_1_43'>If terminated, please explain what you believe was the actual reason that the company terminated you. (If you believe the company truly reduced its workforce, and eliminated one or more positions, please explain why you think they chose you for layoff instead of other employees that hold the same or similar positions. In other words, we want to know what you think the motive was, not what the company told you its reasons were.)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_43' id='input_1_43' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_44\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_44\" ><label class='gfield_label gform-field-label' for='input_1_44'>If you were laid off, pursuant to a reduction in force, were there other employees that held a position similar to yours that was retained by the company when you were laid off? If your claim is discrimination based on age, race, gender, national origin, etc., please also state the age, race, gender, or national origin of the employees that were retained. For each such employee, please also explain why you think that the employee should have been laid off instead of you. For example, if you were laid off over an employee that had less seniority, less experience, less education or training, state that next to the employee&#039;s name. (BE SPECIFIC)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_44' id='input_1_44' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_45\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_45\" ><label class='gfield_label gform-field-label' for='input_1_45'>If your employer told you that it fired you for violating some company policy, or disciplinary rule, or regulation (e.g., absenteeism, tardiness, theft, timecard fraud, unsafe workplace conduct, etc.), please list each and every other employee that you believe engaged in conduct of the same severity and frequency, but was not fired. If your claim is discrimination based on age, race, gender, national origin, etc., please also state the age, race, gender, or national origin of the employees that were retained. If your claim is based on whistleblowing, please state whether the employees that were not disciplined as severly as you also engaged in whistleblowing. Also state what misconduct each of the listed employees actually engaged in, when, how frequently, and the name of any supervisors that knew the employee committed the misconduct that you contend was as severe as that for which you were fired.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_45' id='input_1_45' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_46\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_46\" ><label class='gfield_label gform-field-label' >Did your employer follow company policy and procedure in handling your dispute?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_46'>\n\t\t\t<li class='gchoice gchoice_1_46_0'>\n\t\t\t\t<input name='input_46' type='radio' value='Yes'  id='choice_1_46_0'    \/>\n\t\t\t\t<label for='choice_1_46_0' id='label_1_46_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_46_1'>\n\t\t\t\t<input name='input_46' type='radio' value='No'  id='choice_1_46_1'    \/>\n\t\t\t\t<label for='choice_1_46_1' id='label_1_46_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_46_2'>\n\t\t\t\t<input name='input_46' type='radio' value='I don&#039;t know'  id='choice_1_46_2'    \/>\n\t\t\t\t<label for='choice_1_46_2' id='label_1_46_2' class='gform-field-label gform-field-label--type-inline'>I don&#8217;t know<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_46_3'>\n\t\t\t\t<input name='input_46' type='radio' value='gf_other_choice'  id='choice_1_46_3'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_1_46_other' name='input_46_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_47\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_47\" ><label class='gfield_label gform-field-label' >Do you feel race, age, sex, national origin, religion, sexual orientation, pregnancy, disability (physical or mental), or talking a medical, disability or pregnancy leave of absence was the cause of this difference in treatment?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_47'>\n\t\t\t<li class='gchoice gchoice_1_47_0'>\n\t\t\t\t<input name='input_47' type='radio' value='Yes'  id='choice_1_47_0'    \/>\n\t\t\t\t<label for='choice_1_47_0' id='label_1_47_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_47_1'>\n\t\t\t\t<input name='input_47' type='radio' value='No'  id='choice_1_47_1'    \/>\n\t\t\t\t<label for='choice_1_47_1' id='label_1_47_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_47_2'>\n\t\t\t\t<input name='input_47' type='radio' value='I don&#039;t know'  id='choice_1_47_2'    \/>\n\t\t\t\t<label for='choice_1_47_2' id='label_1_47_2' class='gform-field-label gform-field-label--type-inline'>I don&#8217;t know<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_48\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_48\" ><label class='gfield_label gform-field-label' for='input_1_48'>If you believe that any of the above-listed characteristics might have motivated the employment action taken, please describe in detail, each and every fact upon which you base that conclusion. Possible evidence may include the following: (a) Statements or remarks by management: Examples of possible evidence of racial motive include, racial comments, stereotypes, jokes or comments by management, or comments by co-workers, of which management knew about. Also comments that you are not a \u201cteam player\u201d might indicate a retaliatory motive; (b) Others who were treated more favorably in similar situations: If other employees who did not have your protected characteristic (i.e., were not of the same race, age, gender, or were not disabled), were treated better in similar situations, that may show discriminatory motive. For example, if you are a woman and were fired for being late, the fact that other male employees were also late but were not fired would constitute evidence of discrimination; (c) Statistics: How many total employees at your company vs. how many employees of your gender, race, age or national origin. For example, if your company has only 2% Hispanic employees, but 25% of the applicants are Hispanic, that would tend to prove racism. Also, if Hispanics, or women, or older workers make up only 10% of the workers at your company, but 50% of the terminations or suspensions, that would tend to support an inference that the terminations or suspension decisions were motivated by some protected characteristic.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_48' id='input_1_48' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_92' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_92' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_5' class='gform_page' data-js='page-field-id-92' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_5' class='gform_fields top_label form_sublabel_below description_above'><li id=\"field_1_50\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_50\" ><label class='gfield_label gform-field-label' for='input_1_50'>Provide a brief description of your regular duties and responsibilities:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_50' id='input_1_50' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_51\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_51\" ><label class='gfield_label gform-field-label' >Did you receive a salary or hourly rate?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_51'>\n\t\t\t<li class='gchoice gchoice_1_51_0'>\n\t\t\t\t<input name='input_51' type='radio' value='Yes'  id='choice_1_51_0'    \/>\n\t\t\t\t<label for='choice_1_51_0' id='label_1_51_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_51_1'>\n\t\t\t\t<input name='input_51' type='radio' value='No'  id='choice_1_51_1'    \/>\n\t\t\t\t<label for='choice_1_51_1' id='label_1_51_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_52\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_52\" ><label class='gfield_label gform-field-label' for='input_1_52'>What was your salary or hourly rate?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_1_52' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_53\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_third field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_53\" ><label class='gfield_label gform-field-label' >If you were salaried employee, did you have authority to hire, fire, or issue formal discipline to employees?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_53'>\n\t\t\t<li class='gchoice gchoice_1_53_0'>\n\t\t\t\t<input name='input_53' type='radio' value='Yes'  id='choice_1_53_0'    \/>\n\t\t\t\t<label for='choice_1_53_0' id='label_1_53_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_53_1'>\n\t\t\t\t<input name='input_53' type='radio' value='No'  id='choice_1_53_1'    \/>\n\t\t\t\t<label for='choice_1_53_1' id='label_1_53_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_middle_third field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_54\" ><label class='gfield_label gform-field-label' >Did you work more than 40 hours in work week?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_54'>\n\t\t\t<li class='gchoice gchoice_1_54_0'>\n\t\t\t\t<input name='input_54' type='radio' value='Yes'  id='choice_1_54_0'    \/>\n\t\t\t\t<label for='choice_1_54_0' id='label_1_54_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_54_1'>\n\t\t\t\t<input name='input_54' type='radio' value='No'  id='choice_1_54_1'    \/>\n\t\t\t\t<label for='choice_1_54_1' id='label_1_54_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_55\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_third field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_55\" ><label class='gfield_label gform-field-label' >Were you paid overtime when you worked more than 40 hours in a work week?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_55'>\n\t\t\t<li class='gchoice gchoice_1_55_0'>\n\t\t\t\t<input name='input_55' type='radio' value='Yes'  id='choice_1_55_0'    \/>\n\t\t\t\t<label for='choice_1_55_0' id='label_1_55_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_1'>\n\t\t\t\t<input name='input_55' type='radio' value='No'  id='choice_1_55_1'    \/>\n\t\t\t\t<label for='choice_1_55_1' id='label_1_55_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_56\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gf_left_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_56\" ><label class='gfield_label gform-field-label' for='input_1_56'>If you believe you were not paid or underpaid for hours you worked, please explain:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_56' id='input_1_56' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_57\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_57\" ><label class='gfield_label gform-field-label' for='input_1_57'>If you were terminated from your employment, did you complain about unpaid work hours or overtime or underpayment of wages prior to your termination?<\/label><div class='ginput_container ginput_container_text'><input name='input_57' id='input_1_57' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_93' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_93' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_6' class='gform_page' data-js='page-field-id-93' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_6' class='gform_fields top_label form_sublabel_below description_above'><li id=\"field_1_58\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_58\" ><label class='gfield_label gform-field-label' >Was your work performance evaluated in writing?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_58'>\n\t\t\t<li class='gchoice gchoice_1_58_0'>\n\t\t\t\t<input name='input_58' type='radio' value='Yes'  id='choice_1_58_0'    \/>\n\t\t\t\t<label for='choice_1_58_0' id='label_1_58_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_58_1'>\n\t\t\t\t<input name='input_58' type='radio' value='No'  id='choice_1_58_1'    \/>\n\t\t\t\t<label for='choice_1_58_1' id='label_1_58_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_59\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_59\" ><label class='gfield_label gform-field-label' >Have you received any commendations, letters, or memos telling you that you were doing a good job?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_59'>\n\t\t\t<li class='gchoice gchoice_1_59_0'>\n\t\t\t\t<input name='input_59' type='radio' value='Yes'  id='choice_1_59_0'    \/>\n\t\t\t\t<label for='choice_1_59_0' id='label_1_59_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_59_1'>\n\t\t\t\t<input name='input_59' type='radio' value='No'  id='choice_1_59_1'    \/>\n\t\t\t\t<label for='choice_1_59_1' id='label_1_59_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_60\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_60\" ><label class='gfield_label gform-field-label' >Have you ever been disciplined, counseled, or warned about deficiencies in your work performance or violations of company policy at any time during your employment?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_60'>\n\t\t\t<li class='gchoice gchoice_1_60_0'>\n\t\t\t\t<input name='input_60' type='radio' value='Yes'  id='choice_1_60_0'    \/>\n\t\t\t\t<label for='choice_1_60_0' id='label_1_60_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_60_1'>\n\t\t\t\t<input name='input_60' type='radio' value='No'  id='choice_1_60_1'    \/>\n\t\t\t\t<label for='choice_1_60_1' id='label_1_60_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_61\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_61\" ><label class='gfield_label gform-field-label' >Have you ever been terminated or asked to resign from employment in the last 10 years?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_61'>\n\t\t\t<li class='gchoice gchoice_1_61_0'>\n\t\t\t\t<input name='input_61' type='radio' value='Yes'  id='choice_1_61_0'    \/>\n\t\t\t\t<label for='choice_1_61_0' id='label_1_61_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_61_1'>\n\t\t\t\t<input name='input_61' type='radio' value='No'  id='choice_1_61_1'    \/>\n\t\t\t\t<label for='choice_1_61_1' id='label_1_61_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_94' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_94' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"7\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"7\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_7' class='gform_page' data-js='page-field-id-94' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_7' class='gform_fields top_label form_sublabel_below description_above'><li id=\"field_1_64\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_64\" ><label class='gfield_label gform-field-label' >Did you inform a supervisor or manager of your complaint?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_64'>\n\t\t\t<li class='gchoice gchoice_1_64_0'>\n\t\t\t\t<input name='input_64' type='radio' value='Yes'  id='choice_1_64_0'    \/>\n\t\t\t\t<label for='choice_1_64_0' id='label_1_64_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_64_1'>\n\t\t\t\t<input name='input_64' type='radio' value='No'  id='choice_1_64_1'    \/>\n\t\t\t\t<label for='choice_1_64_1' id='label_1_64_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_65\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_65\" ><label class='gfield_label gform-field-label' >Was your complaint in writing?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_65'>\n\t\t\t<li class='gchoice gchoice_1_65_0'>\n\t\t\t\t<input name='input_65' type='radio' value='Yes'  id='choice_1_65_0'    \/>\n\t\t\t\t<label for='choice_1_65_0' id='label_1_65_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_65_1'>\n\t\t\t\t<input name='input_65' type='radio' value='No'  id='choice_1_65_1'    \/>\n\t\t\t\t<label for='choice_1_65_1' id='label_1_65_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_66\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_66\" ><label class='gfield_label gform-field-label' >Does your company have an internal complaint procedure?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_66'>\n\t\t\t<li class='gchoice gchoice_1_66_0'>\n\t\t\t\t<input name='input_66' type='radio' value='Yes'  id='choice_1_66_0'    \/>\n\t\t\t\t<label for='choice_1_66_0' id='label_1_66_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_66_1'>\n\t\t\t\t<input name='input_66' type='radio' value='No'  id='choice_1_66_1'    \/>\n\t\t\t\t<label for='choice_1_66_1' id='label_1_66_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_67\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_67\" ><label class='gfield_label gform-field-label' >Have you filed a Union grievance?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_67'>\n\t\t\t<li class='gchoice gchoice_1_67_0'>\n\t\t\t\t<input name='input_67' type='radio' value='Yes'  id='choice_1_67_0'    \/>\n\t\t\t\t<label for='choice_1_67_0' id='label_1_67_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_67_1'>\n\t\t\t\t<input name='input_67' type='radio' value='No'  id='choice_1_67_1'    \/>\n\t\t\t\t<label for='choice_1_67_1' id='label_1_67_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_68\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_68\" ><label class='gfield_label gform-field-label' >Have you filed a charge or complaint with a state or federal agency (e.g., Equal Employment Opportunity Commission, U.S. Dept. of Labor, Arizona Civil Rights Division, California Dept. of Fair Employment and Housing)?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_68'>\n\t\t\t<li class='gchoice gchoice_1_68_0'>\n\t\t\t\t<input name='input_68' type='radio' value='Yes'  id='choice_1_68_0'    \/>\n\t\t\t\t<label for='choice_1_68_0' id='label_1_68_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_68_1'>\n\t\t\t\t<input name='input_68' type='radio' value='No'  id='choice_1_68_1'    \/>\n\t\t\t\t<label for='choice_1_68_1' id='label_1_68_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_69\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_69\" ><label class='gfield_label gform-field-label' >Have you received a &quot;Right to Sue&quot; letter?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_69'>\n\t\t\t<li class='gchoice gchoice_1_69_0'>\n\t\t\t\t<input name='input_69' type='radio' value='Yes'  id='choice_1_69_0'    \/>\n\t\t\t\t<label for='choice_1_69_0' id='label_1_69_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_69_1'>\n\t\t\t\t<input name='input_69' type='radio' value='No'  id='choice_1_69_1'    \/>\n\t\t\t\t<label for='choice_1_69_1' id='label_1_69_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_70\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_70\" ><label class='gfield_label gform-field-label' >Do you have a copy of any charge filed with the state or federal agency?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_70'>\n\t\t\t<li class='gchoice gchoice_1_70_0'>\n\t\t\t\t<input name='input_70' type='radio' value='Yes'  id='choice_1_70_0'    \/>\n\t\t\t\t<label for='choice_1_70_0' id='label_1_70_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_70_1'>\n\t\t\t\t<input name='input_70' type='radio' value='No'  id='choice_1_70_1'    \/>\n\t\t\t\t<label for='choice_1_70_1' id='label_1_70_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_71\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_71\" ><label class='gfield_label gform-field-label' >If terminated, have you applied for unemployment benefits?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_71'>\n\t\t\t<li class='gchoice gchoice_1_71_0'>\n\t\t\t\t<input name='input_71' type='radio' value='Yes'  id='choice_1_71_0'    \/>\n\t\t\t\t<label for='choice_1_71_0' id='label_1_71_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_71_1'>\n\t\t\t\t<input name='input_71' type='radio' value='No'  id='choice_1_71_1'    \/>\n\t\t\t\t<label for='choice_1_71_1' id='label_1_71_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_72\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_72\" ><label class='gfield_label gform-field-label' >Did anyone appeal the initial decision of the unemployment office?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_72'>\n\t\t\t<li class='gchoice gchoice_1_72_0'>\n\t\t\t\t<input name='input_72' type='radio' value='Yes'  id='choice_1_72_0'    \/>\n\t\t\t\t<label for='choice_1_72_0' id='label_1_72_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_72_1'>\n\t\t\t\t<input name='input_72' type='radio' value='No'  id='choice_1_72_1'    \/>\n\t\t\t\t<label for='choice_1_72_1' id='label_1_72_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_73\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_73\" ><label class='gfield_label gform-field-label' >Have you examined your personnel file?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_73'>\n\t\t\t<li class='gchoice gchoice_1_73_0'>\n\t\t\t\t<input name='input_73' type='radio' value='Yes'  id='choice_1_73_0'    \/>\n\t\t\t\t<label for='choice_1_73_0' id='label_1_73_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_73_1'>\n\t\t\t\t<input name='input_73' type='radio' value='No'  id='choice_1_73_1'    \/>\n\t\t\t\t<label for='choice_1_73_1' id='label_1_73_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_95' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_95' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"8\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"8\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_8' class='gform_page' data-js='page-field-id-95' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_8' class='gform_fields top_label form_sublabel_below description_above'><li id=\"field_1_74\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_74\" ><label class='gfield_label gform-field-label' for='input_1_74'>Describe the effect of your discharge or other action taken against you by your employer on your income, medical or pension benefits, profit sharing, or other financial impact:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_74' id='input_1_74' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_76\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_76\" ><label class='gfield_label gform-field-label' for='input_1_76'>Describe the effects of your discharge or other action taken against you by your employer on your health and\/or personal life, family relations, and opportunities for other employment:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_76' id='input_1_76' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_77\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_77\" ><label class='gfield_label gform-field-label' >Have you sought any medical treatment or counseling because of your employment problems?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_77'>\n\t\t\t<li class='gchoice gchoice_1_77_0'>\n\t\t\t\t<input name='input_77' type='radio' value='Yes'  id='choice_1_77_0'    \/>\n\t\t\t\t<label for='choice_1_77_0' id='label_1_77_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_77_1'>\n\t\t\t\t<input name='input_77' type='radio' value='No'  id='choice_1_77_1'    \/>\n\t\t\t\t<label for='choice_1_77_1' id='label_1_77_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_96' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"7\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"7\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_96' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"9\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"9\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_9' class='gform_page' data-js='page-field-id-96' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_9' class='gform_fields top_label form_sublabel_below description_above'><li id=\"field_1_79\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_79\" ><label class='gfield_label gform-field-label' >Have you ever complained to any employer, formally or informally, orally or in writing, about harassment or discrimination, or filed any other discrimination complaint against this employer or any other previous employer with either the company or a state or federal agency?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_79'>\n\t\t\t<li class='gchoice gchoice_1_79_0'>\n\t\t\t\t<input name='input_79' type='radio' value='Yes'  id='choice_1_79_0'    \/>\n\t\t\t\t<label for='choice_1_79_0' id='label_1_79_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_79_1'>\n\t\t\t\t<input name='input_79' type='radio' value='No'  id='choice_1_79_1'    \/>\n\t\t\t\t<label for='choice_1_79_1' id='label_1_79_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_80\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_80\" ><label class='gfield_label gform-field-label' >Have you ever filed a lawsuit before or have you ever been sued before?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_80'>\n\t\t\t<li class='gchoice gchoice_1_80_0'>\n\t\t\t\t<input name='input_80' type='radio' value='Yes'  id='choice_1_80_0'    \/>\n\t\t\t\t<label for='choice_1_80_0' id='label_1_80_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_80_1'>\n\t\t\t\t<input name='input_80' type='radio' value='No'  id='choice_1_80_1'    \/>\n\t\t\t\t<label for='choice_1_80_1' id='label_1_80_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_81\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_81\" ><label class='gfield_label gform-field-label' >Have you ever filed for bankruptcy before, or are you considering filing bankruptcy in the near future?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_81'>\n\t\t\t<li class='gchoice gchoice_1_81_0'>\n\t\t\t\t<input name='input_81' type='radio' value='Yes'  id='choice_1_81_0'    \/>\n\t\t\t\t<label for='choice_1_81_0' id='label_1_81_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_81_1'>\n\t\t\t\t<input name='input_81' type='radio' value='No'  id='choice_1_81_1'    \/>\n\t\t\t\t<label for='choice_1_81_1' id='label_1_81_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_82\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_82\" ><label class='gfield_label gform-field-label' >Have you ever filed a worker&#039;s compensation claim for any injuries sustained at work?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_82'>\n\t\t\t<li class='gchoice gchoice_1_82_0'>\n\t\t\t\t<input name='input_82' type='radio' value='Yes'  id='choice_1_82_0'    \/>\n\t\t\t\t<label for='choice_1_82_0' id='label_1_82_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_82_1'>\n\t\t\t\t<input name='input_82' type='radio' value='No'  id='choice_1_82_1'    \/>\n\t\t\t\t<label for='choice_1_82_1' id='label_1_82_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_83\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_83\" ><label class='gfield_label gform-field-label' >Since your termination, have you looked for other employment?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_83'>\n\t\t\t<li class='gchoice gchoice_1_83_0'>\n\t\t\t\t<input name='input_83' type='radio' value='Yes'  id='choice_1_83_0'    \/>\n\t\t\t\t<label for='choice_1_83_0' id='label_1_83_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_83_1'>\n\t\t\t\t<input name='input_83' type='radio' value='No'  id='choice_1_83_1'    \/>\n\t\t\t\t<label for='choice_1_83_1' id='label_1_83_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_84\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_84\" ><label class='gfield_label gform-field-label' >Is ANYTHING you stated on your application for the job from which you were fired false or misleading in any way? [We need to know this information to assist you in minimizing any harm because once litigation commences, your former employer WILL subpoena all records and learn whether anything you said was untrue].<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_84'>\n\t\t\t<li class='gchoice gchoice_1_84_0'>\n\t\t\t\t<input name='input_84' type='radio' value='Yes'  id='choice_1_84_0'    \/>\n\t\t\t\t<label for='choice_1_84_0' id='label_1_84_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_84_1'>\n\t\t\t\t<input name='input_84' type='radio' value='No'  id='choice_1_84_1'    \/>\n\t\t\t\t<label for='choice_1_84_1' id='label_1_84_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_88\" class=\"gfield gfield--type-section gfield--input-type-section gsection gf_scroll_text field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_88\" ><h2 class=\"gsection_title\">Terms of Use<\/h2><div class='gsection_description' id='gfield_description_1_88'>By selecting &#8220;yes&#8221; below, you&#8217;re agreeing: I am submitting the above and enclosed for you review. I understand that: (1) The submission of the information in this questionnaire and any other information is being submitted for your reviewing purposes only; (2) you have made no decision on whether you will take any case for me, and may not do so for some time; (3) it takes time for Thunderbird Law Group PLLC to review the material submitted and to make any reply to this inquiry; (4) further information from me may be necessary in order for Thunderbird Law Group PLLC to make a decision; (5) IF THERE IS AN IN-OFFICE  CONSULTATION, THERE IS A NON-REFUNDABLE FEE OF $400.00, whether you take any case for me or not; (6) the submission of this questionnaire and any other information does not create an attorney-client relationship; such a relationship will only be created by a proper  written agreement to that effect; (7) There are certain time limits involved in legal proceedings,  and if those time limits pass, certain of my rights may be lost and\/or affected otherwise. I assume the risk that such time limits might pass before Thunderbird Law Group PLLC makes any decision on this matter and\/or can take any legal action; (8) although what time limits apply to employment cases  are not always certain, your law office needs to have the completed materials in hand at least  ninety (90) days before the one year anniversary of the day you were notified of your termination, or the last act of discrimination took place; (9) Thunderbird Law Group PLLC does not guarantee that he will take your case on a contingency basis. I certify that the information contained in this questionnaire and any attachments hereto is true and correct to the best of my knowledge and belief.<\/div><\/li><li id=\"field_1_89\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_89\" ><label class='gfield_label gform-field-label' >Do you agree to Thunderbird Law Group PLLC Terms of Use?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_89'>\n\t\t\t<li class='gchoice gchoice_1_89_0'>\n\t\t\t\t<input name='input_89' type='radio' value='I Agree'  id='choice_1_89_0'    \/>\n\t\t\t\t<label for='choice_1_89_0' id='label_1_89_0' class='gform-field-label gform-field-label--type-inline'>I Agree<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_89_1'>\n\t\t\t\t<input name='input_89' type='radio' value='I Disagree'  id='choice_1_89_1'    \/>\n\t\t\t\t<label for='choice_1_89_1' id='label_1_89_1' class='gform-field-label gform-field-label--type-inline'>I Disagree<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='if(window[\"gf_submitting_1\"]){return false;}  if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_1\"]){return false;} if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;}  jQuery(\"#gform_1\").trigger(\"submit\",[true]); 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